<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Heart surgery is used to treat serious heart diseases.
</sec>
<sec><title style='display:none'>METHODS</title>
This is a perspective article on heart surgeries, by reviewing the papers on Europe percutaneous mitral commissurotomy (PMC) concerning heart surgeries, as Europe PMC is a trusted academic engine. The author included all papers on the subject, but papers from the last 5 years are the favorite for references, without exclusion from review.
</sec>
<sec><title style='display:none'>RESULTS</title>
There are 192,265 case reports (28.5%), 143,267 clinical trials (21.2%), 303,690 reviews (45%), and 34,323 miscellaneous (5%).
</sec>
<sec><title style='display:none'>CONCLUSIONS</title>
Artificial intelligence is the future of advances in heart surgeries as they are highly distributed in the world.
</sec>
</abstract>

Artificial Intelligence Enhances Heart Surgeries

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Left atrial (LA) myxoma’s clinical manifestation depends on the size, location, mobility, and architecture of the tumor. The clinical presentation consists of cardiac (67%), embolic (29%), and systemic (34%) symptoms, even sudden cardiac death.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
We present an interesting case and images of a patient with severe mitral valve dysfunction and syncope, who was diagnosed with a giant mass in the left atrium and left ventricle as myxomas. Open heart surgery was performed and the mass was detected and successfully removed. The histopathology confirmed the diagnosis of myxoma of the left atrium.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Myxoma may be challenging to diagnose, but with imaging techniques, such as transthoracic (TTE), transesophageal (TEE) echocardiograms, when a high index of clinical suspicion exists, early diagnosis and therefore curative intervention in the majority of the cases is more likely.
</sec>
</abstract>

Severe Mitral Valve Dysfunction: A Giant Left Atrial Myxoma Was the Guilty

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
The following case presentation highlights the diagnostic and therapeutic approach to a patient with a rare disease.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A 47-year-old man was hospitalized with chest pain, shortness of breath, and fatigue. Initial blood test analysis revealed elevated CRP, leukocytosis, and elevated cTn-I. Due to suspected myocarditis, cardiac magnetic resonance (CMR) imaging was performed. CMR ruled out myocarditis. In addition, there were no signs of edema or late gadolinium enhancement (LGE). However, there was evidence of enlarged right ventricular heart chambers. Cine short-axis images and LGE sequences revealed masses in the pulmonary artery, highly suspicious of thrombi. D-dimer was analyzed, showing very high values, and additionally, CTPA confirmed the diagnosis of pulmonary embolism (PE). Venous Doppler ultrasonography demonstrated DVT in the right popliteal vein. Anticoagulation with LMWH was initiated, after which a drug from the NOAC class - Rivaroxaban was given according to a PE protocol. The patient was discharged from the hospital in a hemodynamically stable condition with a recommendation to adhere to the therapy and conduct control after 1 and 3 months of hospitalization.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Thanks to multimodality imaging, we find it easier to get the specific cause of the problem, by establishing it or by ruling it out. However, the most important thing is to have a high clinical suspicion and common sense for faster diagnosis, treatment, and early recovery of the patient.
</sec>
</abstract>

Pulmonary Thromboembolism in a Patient Suspected for Myocarditis - Case Report

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Patient with hemodialysis (HD) is prone to central venous stenosis (CVS). The presence of CVS contributed to poor dialysis adequacy. Symptomatic CVS is treated with percutaneous transluminal angioplasty (PTA) with or without a stent. This report aimed to understand the characteristics of PTA with or without a stent.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A 43-year-old woman was admitted to the hospital with a chief complaint of a deteriorating swollen right arm with pain 1 week prior. Patient had been on HD since 2019, had AV shunt access, continuous ambulatory peritoneal dialysis (CAPD), and 4 times balloon angioplasty due to similar complaints. Diagnoses of the patient were AV shunt stenosis, chronic kidney disease Stage 5 on CAPD, heart failure Stage C FC II, hypertension on treatment, anemia related to renal disease, and severe hypoalbuminemia based on anamnesis and extensive examination. PTA with stent was conducted in this patient and showed TIMI Flow III.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
PTA is the primary treatment for symptomatic CVS. A stent implantation is used in cases that failed PTA treatment. PTA with a stent provides immediate symptom alleviation and benefits an angioplasty-resistant lesion by secondary patency.
</sec>
</abstract>

Management of Refractory Central Vein Stenosis in Hemodialysis Patient

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Heart failure (HF) is a complex clinical syndrome that results when heart’s ability to contract or fill is impaired structurally or functionally. Current guideline has been classified HF according to level of left ventricular ejection fraction (EF). 1) Heart failure with reduced ejection fraction (HRrEF): EF ≤ 40%; 2) Heart failure with mildy ejection fraction (HRmrEF): EF 41 - 49%; 3) Heart failure with preserved ejection fraction (HRpEF): EF ≥50%.
</sec>
<sec><title style='display:none'>AIM</title>
We aimed to analyse the management of heart failure with preserved ejection fraction.
</sec>
<sec><title style='display:none'>METHODS</title>
We conducted a literature search of relevant articles in various databases (Pubmed &amp; Google Scholar). Articles to include in the review was based on agreement of the authors.
</sec>
<sec><title style='display:none'>RESULTS</title>
Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of all heart failure cases. HFpEF remains a challenging condition to diagnose given its unclear and often heterogenous etiology with numerous clinical mimics and complex systemic pathophysiology.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Additionally, effective treatment modalities are limited with numerous negative clinical trials over the past few decades. In this review, we updated the last knowledge of management HFpEF by reviewing recent guideline and studies.
</sec>
</abstract>

Management Heart Failure with Preserved Ejection Fraction: A Mini Review

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Health problems with cardiovascular system disorders including congestive heart failure (CHF) still rank highly. CHF is one of the heart diseases that continue to increase in incidence and prevalence every year, including in Indonesia. Lack of health education about how home care is a factor increases the incidence of rehospitalization in CHF patients. Here, researchers have provided knowledge to patients about how things to avoid, foods to avoid, recommended foods, and diet to do.
</sec>
<sec><title style='display:none'>OBJECTIVE</title>
This study aimed to analyze effectiveness of health management education for CHF patients in Surabaya.
</sec>
<sec><title style='display:none'>METHODS</title>
The research method used is quantitative analytics with a pre-experimental design with an approach (one group pre-post-test design). The population in this study was all CHF patients admitted to hospitals in Surabaya as many as 150 respondents. Sampling using accidental sampling technique. Data were analyzed using and Wilcoxon test.
</sec>
<sec><title style='display:none'>RESULTS</title>
Wilcoxon test results obtained knowledge (p = 0.000), diet (p = 0.001), and physical activity (p = 0.001) which means there is an influence on providing health management education for CHF patients.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Health management education effectiveness for CHF patients in Surabaya. Health-care providers can add health education programs for patients with CHF or other diseases, as a form of nursing service implementation.
</sec>
</abstract>

Effectiveness of Health Management Education for Congestive Heart Failure Patients in Surabaya

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Aortic dissection refers to the disruption of the medial layer of the aorta caused by intramural hemorrhage. This leads to the separation of the layers of the aortic wall, resulting in the establishment of a true lumen and a false lumen, which may or may not be connected. The prevalence of aortic dissection ranges from 0.2% to 0.8%. Additionally, a notable percentage, surpassing 20%, of individuals exhibit a familial inclination towards thoracic aorta dissection.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A male patient in his middle age, 41 years old, with risk factors of uncontrolled hypertension, obesity, and a familial propensity to aortic dissection, presented to the emergency department exhibiting symptoms of chest pain. It characterized the sensation as having a tearing quality and indicated that it extended towards the abdomen region. The results of the test revealed several notable findings. A blood pressure reading of 235/133, a wider mediastinum and cardiomegaly on the chest X-ray, a slight increase in Hs-Troponin levels, and an electrocardiogram showed sinus rhythm with left ventricular hypertrophy. He underwent a computed tomography scan, which revealed the existence of an aortic dissection that extended from the ascending to the descending aorta without any aortic valve involvement. He was assessed with a Stanford A. DeBakey I aortic dissection, and underwent successful therapy for aortic arch replacement with the elephant trunk procedure, and plans to undertake an endovascular procedure for the descending aorta in the upcoming period.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Aortic dissection is a pathological disorder that may exhibit hereditary inheritance, and the choice of surgical technique is dependent on the specific underlying disease.
</sec>
</abstract>

Inherited Stanford A DeBakey I Aortic Dissection: Unveiling Genetic Predispositions and Surgical Management

<abstract>
<title style='display:none'>Abstract</title>
Acute myocard infarct during pregnancy is a rare event with high mortality and women with cardiac comorbid such as hypercholesterolemia, hypertension, and history of myocardial infarction are one of risk that should be warning. However, the main etiology myocard infarct in pregnancy is spontaneous coronary artery dissection, especially in the third semester. Women with unusual chest pain, ST-elevation in electrocardiogram, and sudden cardiac arrest should treat as soon as possible. Patient with unstable condition revascularization is recommended. However, there are several things that should be monitor during revascularization such as consideration type of stent, how much contrast that will be use, and planning after stent implantation. Thrombolysis should be the last option because of bleeding risk. Therapy during and after pregnancy should be monitor continuously because of their side effect to mother and baby, and delivery in women with acute myocard infarct should be one of main concerns. With this review, we hope that we can raise our awareness in pregnant women with their comorbid and their future pregnancy.
</abstract>

Myocardial Infarction in Pregnancy: What Should We Do?

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
With an overall incidence of congenital cardiac disease, tetralogy of fallot (ToF) is the most clinical of cyanotic heart disease. The anomalies seen in patients with ToF are due to an inappropriate anterior and cephalad displacement of the interventricular septum’s infundibular (outflow tract) component. Ventricular septal defect, right ventricular hypertrophy, overriding aorta, and pulmonary stenosis are the four defects that result from this condition. The physiology of healthy women will undergo several changes affecting body system, including the cardiovascular system. Pregnancy and delivery have a high risk for most ill women, including those with uncorrected ToF, due to extensive physiological adaption and alterations. For patients with ToF, it continues to be a significant contributor to maternal morbidity (62.5%), mortality (10%), and neonatal adverse outcomes.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
A 18-year-old female in her first pregnancy at 28 weeks was referred to Saiful Anwar Hospital with uncorrected ToF since she was 2 years old. She suggested repairing ToF at National Cardiovascular Center Harapan Kita Jakarta but her parents still refused. She married at 18 years old and she was pregnant unplanned before. Then, she was referred to RSSA for further management.
</sec>
<sec><title style='display:none'>CONCLUSSION</title>
Pregnancy has been related with higher risks of morbidity and mortality for women with congenital cardiac disease. ToF is the most prevalent cyanosis congenital heart disease. These are poorly tolerated and produce serious complications, including maternal and neonatal mortality. Prenatal counseling is crucial to identify risk factors for the patients and to reassure many patients who are at low risk.
</sec>
</abstract>

Successful Pregnancy with Uncorrected Tetralogy of Fallot: An Interdisciplinary Team Approach

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>BACKGROUND</title>
Myocardial infarction is the leading cause of the occlusion of the coronary artery. Meanwhile, right ventricular myocardial infarction (RVMI) is usually associated with inferior left ventricular infarction in 10–50% of cases. We presented isolated RV infarcts which are rare cases that happen in only 3% of total myocardial infarction.
</sec>
<sec><title style='display:none'>CASE PRESENTATION</title>
We presented a case of a 67-year-old man with sudden chest pain, shortness of breath, and a history of diabetes mellitus. From his 12 lead electrocardiogram, there is no specific ST elevation yet elevation in V3R and V4R and elevated troponin I highly sensitive value. The patient developed junctional bradycardia and early percutaneous coronary intervention backup temporary pacemaker showed total occlusion in the proximal right coronary artery (RCA)
</sec>
<sec><title style='display:none'>CONCLUSION</title>
The RVMI commonly occurs in the dominant RCA that also supplies the sinoatrial node and atrioventricular node. Therefore, due to its location that passed through the RCA, bradycardia to complete heart block may happen. Isolated right ventricular (RV) infarction may happen because either RV marginal as the predominant location is occluded, or non-dominant RCA occluded by thrombus. RV infarction may impair RV contractility causing a decrease in RV stroke volume and this condition leads to hypotension, shock, and severe hemodynamic derangement. Meanwhile, acute proximal RCA occlusions do not result in significant RV necrosis, one of the reasons is collateral flow from the left coronary system further protects from RV dysfunctions in our patient.
</sec>
</abstract>

Isolated Right Ventricular Infarction without Right Ventricular Dysfunction: A Case Report

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>AIMS</title>
Transradial (TR) carotid artery stenting (CAS) has been established as an acceptable alternative to carotid endarterectomy, especially in patients with a high risk for surgery. The purpose of this study was to evaluate the gender differences of radial access CAS in high-risk patients.
</sec>
<sec><title style='display:none'>MATERIALS AND METHODS</title>
This was a prospective analysis which included 54 consecutive patients in the period from December 2020 to January 2022. According to the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy study for high-risk CAS, patients with at least one anatomic or comorbid factor associated with increased surgical risk were included in the study. Subjects were divided into two groups according to sex. Follow-up assessments included neurological exams, 12-lead electrocardiogram, and duplex ultrasound (DUS). The primary endpoint was 30-day composite rate of stroke, death, and myocardial infarction. Secondary endpoints included procedure success, access site complications according to Early Discharge after TR Stenting of Coronary Arteries (EASY) score classification, target lesion revascularization, and in-stent restenosis evaluated with DUS.
</sec>
<sec><title style='display:none'>RESULTS</title>
The study population was predominantly male 37 (61.1%) and females were 17 (38.9%). Mean age in the women group was 64.4 ± 7.43 years, and in men, it was 69.1 ± 8.01 years (p = 0.0223). From risk factors for coronary artery disease, hypertension and smoking were more frequent in the male group and hyperlipidemia and diabetes in the female group. Most of the male patients were symptomatic compared to the female group (p = 0.0151). Procedural success was obtained in all cases. Transient vasospasm induced by the distal protection device was present in one male patient. No 30-day major adverse events were recorded between the two groups. Minor access site bleeding complications according to EASY score (Easy type 1) were recorded in 4 patients (3 males vs. 1 female). There were no cases of hand ischemia after procedure or follow-up. None of the patients had in-stent restenosis &gt;70% on DUS during 1-year follow-up.
</sec>
<sec><title style='display:none'>CONCLUSION</title>
Results from this study demonstrate no gender-related differences in radial access CAS for high-risk patients.
</sec>
</abstract>

Gender Differences in High-risk CAS through Radial Access

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South East European Journal of Cardiology

The Journal of Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia

 The South East European Journal of Cardiology (SEEJCA) is an open-access, peer-reviewed journal, founded in 2015 and is restarting its’ publication process this year. SEEJCA is...

 The South East European Journal of Cardiology (SEEJCA) is an open-access, peer-reviewed journal, founded in 2015 and is restarting its’...

South East European Journal of Cardiology

The Journal of Scientific Foundation SPIROSKI, Skopje, Republic of Macedonia

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